Monthly Archives: September 2013

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Ratna is excited by the childbirth education materials I brought. We are designing a great program….

Sapana is excited by a class on birth positions. Praticing giving birth on the birth stool!

A satisfied mamma

Rashmi (and I) got VERY EXCITED thinking about all the wonderful things that are going to happen at the Birth Center…..

Rashmi and I have spent quite a lot of time thinking, talking and planning and I have a MUCH clearer idea of what is needed and lots of very specific work to do.
We are designing a birth center brochure (3 or 4 of the young midwives and myself). We are planning a childbirth education curriculum and maybe it will be up and running within a few weeks. We are discussing reorganizing the flow of the birth center. We are discussing financial priorities. It is all very concrete and GOOD.

And I am having fun! Thanks to all of you who are following me on this blog,,,,

Today and the next few days are different. I was just beginning to feel a sense of routine….then…..

To explain: Hannah B was in the grade above me in High School 40 years ago. She moved to Israel about when I did and we have a mutual friend (one of my closest friends in Israel). So, she discovered that I would be in Kathmandu and she is visiting tomorrow, alone, and looking for someone to go into the mountains with her. As I am alone, it seemed like an opportunity not to forgo even though it is a little early in my trip to take off. So tomorrow I will go to the foothills at Nagarkot, take a deep breath of Himalayas and walk down to the temple town of Bakhtapur with Hannah, before going back to some birth center work on thursday.

Today I went to a birth center health post in the hills at Pharping about 1 1/2 hours from Kathmandu. It was great to escape the dust and hurtle around some hairpin bends to the beauty and quiet of this center, where Kamila, the midwife, gave another Tikka welcome and showed us around. (I was with Trudy and Amanda, UK midwives who are going home in a few days time)

Lots of photos today, the birth center is very photogenic. Being rural, it has a very different feel from APS. In some ways it is well equipped. They have a microscope! In others, strangely lacking. They have no ambubag for infant resuscitation. Such a simple, essential item. If only I had known!

On the way: pond at Taudaha home to the nagas (serpent deity)

Another Tikka welcome

Kamala, the midwife at Phoping, with her birth log

Community health workers here to be trained by Kamila

Beautiful Birth center garden

View from the birth center

Just a few hours getting a feel for the center and drinking tea, and then back to the city.

Here arae some picks I took this afternoon all yards from my guest house. Photogenic every direction

Don’t want to get too obsessive about my sleep in this blog, but it’s been a major feature of my life…. Trying to sleep. The night before last I slept very well. Halleluya. I awoke, excited to feel so good! My guest house includes breakfast and it’s 2 eggs, potatoes, tomatoes, mango juice, tea and 2 pieces of toast with butter and jam. Way more food than I normally would eat, but I have been eating it all! So I have my huge breakfast and get set on my way to the birth center.

The center is about 20 minutes away by taxi. The taxis are my biggest daily expense, $3 each way. The ride is wild, scary fun, nutty, indescribable but I will try. My street which connects Poknajol to Chetrapatti, is paved, although most are not. The street is full of walkers bicycles, scooters, motorbikes, pedal rickshaws, push-carts, stray dogs (many looking much the worse for wear) and the occasional cow as well as trucks and cars (mostly taxis) and workmen with handtools doing various repair jobs in the street. I hurtle along in my vehicle as we approach Chetrapatti which is a sort of a roundabout with a temple in the middle, around which rush vehicles and pedestrians in a wild dance of weaving in a variety of directions, horns blaring constantly. We dive out onto an unpaved lane that dips downward towards the filthy river. I can practically grab pieces of fruit or a piping hot chapati as we rush by. We careen through a variety of similar turns and bumps, pass along a wider road with many pedestrians stepping out in front of vehicles as they try courageously to cross the sea of traffic, duck under a huge rusty metal bridge onto the ring road, right down a small dirt track and we reach the birth center. Deep breath. Safe and sound. What a ride for $3.

Yesterday, had a short class on oxytocin and its various functions. Then Rashmi, the head midwife showed up. She is usually so busy, but was in relaxed mood, and we chatted a lot about birth center mangaement and her challenges. Then she took me out to a super wonderful dive where we watched the women making chapatis on the fire in front of us and ate them hot hot with a spicey bean soup. Followed by spicey tea mmmmm. Good! Then back to the center for some birth drills.

Today I did a bit of a lesson with a video illustrating midwifery model of care. Very hard to get discussion with these girls. They are not used to being asked questions by the teacher and are hesitant to give wrong anwers. There are no wrong answers!. They are shy but very willing. I bought us all lunch as a treat….. they had done well. After lunch we did some more birth drill stuff. Another good day.

Here are some of the lovely girls watching the video studiously on my laptop. (The laptop has a picture of my three boys. Prena has decided that she will move to Texas and marry Amos, the oldest)

After another absolutely pathetic night of poor sleep, I….. er…. got up. My head still whirling (please stop) partly because visits with midwives yesterday dragged my thinking in so many different directions. Kiran, the head of Midwifery Society of Nepal is very into her political efforts to professionalize and this colors her views of what should be done perhaps and therefore my thinking. Rashmi, head midwife at the birth center, speaks English that is hard to understand and not sure what she wants. Rashmi works full time as head nurse at a hospital, does home births on the side and as a second job runs the birth center…… and we think we have a lot to do!

Today I just went in to the birth center at around 10 and spent most of the day with the very young, mostly inexperienced, and delightful midwives there. It was not busy. (More about that later). First, I reviewed with them how the birth center functioned. One, (Prena) had a lot to say. The others seemed pretty shy. Trudy, one of the UK midwives came later. (The UK group leaves next week) and she gave a bit of an inservice on essential oils and massage. We had fun demonstrating stuff together and got into some funny positions. Should have taken pictures.

Then I reviewed record keeping with them. That sounds boring but we had a good time! They are delightful young women but feel very undertrained for the responsibilities of daily running of the birth centre/clinic.

By the way, some corners of the birth center are fairly homey, like this one

Others are really, well, downright depressing.

The Birth room!!!!:

Here are a couple of gorgeous babies and a gorgeous mom. One at the birth center, the other on the street.

So, after feeling that fun and learning was had by all, I went back into town and did some wandering, where I found among other things some great book shops and a place selling some powerfully hot and good soup. Then it started raining. Time to go home and write the blog.

Seeing the Garden of dreams with a delightful local lady who told me here life story.

Third day….. Meetings! Kiran is the President of the Midwifery society of Nepal. Here we are:

Kiran is so busy and also so welcoming. She schedules all her meetings at the same time so we meet each other……. We did manage to chat about what They want me to do. She wants me to present Childbirth education material to the midwives….. Not done that in a while but why not? She wants me to present the material I have on mnaging and running a birth center, Quality Assurance etc Not sure who she want me to do that for. And pieces from some books I brought on evidence based care. She just sort of said “yes” to everything. “wonderful wonderful” We’lll see.

Afternoon to APS birth center. “Tikka” welcome

And here are some pics of the birth center. More details about that tomorrow (Back there in the morning)

Fresh water fo hand washing in the exam room

Midwives off to a home visit!

And tomorrow I will post pics of the birth room and give you more impressions. Time for bed.